Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2000
Comparative Study Clinical TrialComparing Doppler ultrasonography and cerebral oximetry as indicators for shunting in carotid endarterectomy.
To determine the thresholds of selective shunting in carotid endarterectomy during general anesthesia, we compared transcranial Doppler ultrasonography and cerebral oximetry (RSO2). During carotid cross-clamping, RSO2 and mean blood flow velocity in the middle cerebral artery (Vm,mca) was simultaneously monitored in 55 of 59 patients. A relative decrease in Vm,mca to <20% of preclamp velocity was the indication for selective shunting. ⋯ Transcranial Doppler ultrasonography identified patients at risk for ischemia more accurately than RSO2. Relying on RSO2 alone would increase the number of unnecessary shunts because of the low specificity. Accepting higher decreases in RSO2 does not appear reasonable because it bears the risk of a low sensitivity.
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Anesthesia and analgesia · Dec 2000
Comparative Study Clinical TrialBalloon versus conventional laryngoscopy: a comparison of laryngoscopic findings and intubation difficulty.
We compared laryngeal aperture (LA) exposure and endotracheal intubation difficulty scale (IDS) scores between balloon-assisted and conventional laryngoscopy. Thirty-two anesthetized and paralyzed elective surgery patients underwent laryngoscopy with a standard number 4 and a modified number 4 curved blade carrying a 6F Fogarty catheter. The balloon laryngoscopy technique included modified blade tip insertion into the vallecula, Fogarty catheter balloon inflation with 2 mL of air, and blade elevation until LA exposure maximization. ⋯ The data from 27 patients were analyzed. The exposed LA areas were significantly larger with balloon laryngoscopy than conventional (median, interquartile range: 0.94, 0.65-1.80 cm(2) vs. 0.52, 0.39-1.46 cm(2) respectively) (P = 0.027), and the IDS scores lesser (median, interquartile range: 0, 0-1 vs. 1, 0-2 respectively) (P = 0.012). We concluded that balloon laryngoscopy facilitates elective airway management.
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Anesthesia and analgesia · Dec 2000
Clinical TrialCognition after coronary artery surgery is not related to postoperative jugular bulb oxyhemoglobin desaturation.
During the early postoperative period after coronary artery bypass grafting (CABG) surgery, many patients experience jugular bulb oxyhemoglobin desaturation (SjO(2) < 50%). We sought to determine whether SjO(2) during cardiopulmonary bypass and the early postoperative period influenced long-term cognitive performance after CABG surgery. One hundred two patients completed a battery of cognitive tests the day before and 3 mo after CABG surgery. ⋯ Intraoperatively, SjO(2) was determined by intermittent blood sampling, and postoperatively, the area under the curve of SjO(2) < 50% and time was calculated from continuous reflectance oximetry. No significant correlations between cognitive performance and either intra- or postoperative SjO(2) were found. Preoperative cognitive performance was the main determinant of cognition at 3 mo (r(2) = 0.83, P<0.001), and palpable atheroma of the ascending aorta made a small, but significant, contribution to a decline in cognition (r(2) = 0.018, P = 0.001).
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Anesthesia and analgesia · Dec 2000
Case ReportsAnesthesia for fetoscopic fetal surgery: twin reverse arterial perfusion sequence and twin-twin transfusions syndrome.
Twin reversed arterial perfusion sequence and twin-twin transfusion syndrome can be managed by fetoscopic fetal surgery. It is important to consider the fetal, uteroplacental, and maternal issues when choosing an anesthetic technique. We report on three patients with differing anesthetic issues using fetoscopic surgery for umbilical cord coagulation.
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Anesthesia and analgesia · Dec 2000
Aspiration in transtracheal oxygen insufflation with different insufflation flow rates during cardiopulmonary resuscitation in dogs.
We investigated whether transtracheal insufflation of oxygen with different insufflation flow rates protects against aspiration of gastric contents during cardiopulmonary resuscitation (CPR). Its ventilation and oxygenation effects were also evaluated. Cardiac arrest was induced in anesthetized and paralyzed 18 mongrel dogs. ⋯ We conclude that transtracheal oxygen insufflation, but not chest compression alone, was able to maintain oxygenation for 20 min during CPR in dogs with cardiac arrest. Mild hypercapnia was noted in all groups. Chest compression alone caused pulmonary aspiration, whereas insufflation of 10 L O(2)/min provided better protection against pulmonary aspiration than that of 4 L O(2)/min.